Sample Record for 2023-05-11-95
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 994244 DEA: 051F6204 EFIS: 0514000039
QA Service Level: 1
DIST-CO-RTE-PM: 05-SCR-152-1.9
Work Description: WIDEN BRIDGE, CONCRETE BARRIER, AND MODIFY ELECTRICAL SYSTEM.
Location Description: SANTA CRUZ COUNTY NEAR WATSONVILLE AT CORRALITOS CREEK BRIDGE
Contractor Name: Bridgeway Civil Constructors, Inc
Contractor Address: 3333 Vaca Valley Parkway, Suite 2000, Vacaville, CA 95688
Resident Engineer: David Hopper Structure Rep.: David Galarza
Sample Information
DIME Sample ID: 2023-05-11-95
TL Number from the TL Form:
Sample Submitted By Organization: RMA Group - Rancho Cordova
Sample Organization Contact: (916) 631-7194
Type of Sample: Quality Control
Type of Material: Concrete
Sample Taken Date: 05/11/2023
Date that the sample was received by the laboratory/organization performing the testing: 05/11/2023
The quantity of what the sample constitutes: 100 cy
A brief description of the sample: concrete
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Grainterock
Material Information
The concrete mix design number: 577750E6
The truck number from where the sample was collected: 2425
The batch plant ticket number from where the sample was collected: 420958
Concrete batch plant:
The fabricator/manufacturer designation for the sample:
A detailed description of where the material sample was collected: concrete truck
Where the material sample would have been placed if not sampled:
From Lot No.:
Bag Lot No.:
Test Results
